implementing lung cancer screening at d-h current methods

IMPLEMENTING LUNG CANCER SCREENING AT D-H

Current Methods

Suzanne LenzWendy Oliver

Caitlyn MacGlaflin, Sarah McDougall, Melissa Friedman

Suzanne Lenz and Wendy Oliver have no actual or potential conflict of interest in relation to this program or presentation.

DISCLOSURE

All patients will go through agreed upon process based on USPSTF recommendations.

Informed decision making major part of the process.

COMMITTEE GOALS

Correct exam /correct order Patients meet all eligibility requirements All patients participate in informed decision

making Educate referring providers on our process

◦ Provide Clinic Profile and patient education materials

Keep providers informed◦ Patient “self refers”◦ Patient’s status within the process

Schedule screening exams in a timely manner

COMMITTEE GOALSbefore screening

Each screening result is reviewed by coordinator

Referring provider and patient receive results

Patient and provider receive and understand follow-up recommendations

Immediate or near term follow up recommendations are tracked and expedited

Quality measures are obtained

COMMITTEE GOALS after screening

Offer and arrange smoking cessation counseling◦ For all patients – eligible or not

Inform patients of financial issues

Assist patients without a PCP or insurance

Educate / inform ineligible patients re: low risk

Determine patient interest in future research

Develop and maintain database◦ Patient data, tracking, quality measures/improvement

ADDITIONAL GOALS

33% Coordinator Time◦ funded through June 30 by Cancer Center

Existing “Resources” Utilized◦ Interdisciplinary Thoracic Oncology Clinic◦ CT Surgery ◦ Radiology◦ Cancer Center

RESOURCES

4-Part Process ◦ 7 page word document (text + drop down menus)◦ Shared on secure folder - Radiology I:Drive

Two “pools” or teams

◦ Screening Access Line (SAL) 3 staff members

◦ Coordinator Pool (CP) Currently 1 staff member

◦ Communication via eDH In-Basket system

CURRENT METHODS

All referrals/requests routed to SAL for intake and process initiation

SAL

CP order query

D-H provider

Outside provider

Patient

Source of Intake to Screening Process

1. eDH Workbench and Image Cast queries: CP D-H providers Can “catch” ordered and scheduled exams Reviewed and routed to SAL

2. Outside or direct provider calls & referrals to SAL

3. Patient inquiry for self or family member to SAL CP informs / communicates with D-H providers SAL informs outside providers

METHODS CONTINUED

Part 1SAL

• Collect patient / provider / eligibility data• Patient educational materials sent• Inform providers: self referrals + program

process +patient materials + order

Part 2CoordinatorPre Screen

• Confirm eligibility + medical / imaging history

• Informed decision making• Address patient questions• Schedule screening exam

Part 2 After Screen

• Review Results• Determine next steps for patient• Results to patient + provider• Arrange follow-up per provider preference

Review statement with patient: “I understand that I am at increased risk to develop lung cancer and may benefit from screening for lung cancer with low-dose chest CT. I also understand that there are both potential benefits and harms to screening. I have had an opportunity to ask questions about the screening process. I agree to be screened with the reports sent to me and to my provider.”

Part 3Coordinator Pool

• Quality Measures

Part 4Coordinator

• Final check• Immediate / near term follow

up arranged• All data logged for tracking

+ patient notifications

Transfer process form to an eDH system

Track patients in eDH◦ Status during screening process◦ Follow up after screening

In conjunction with other disciplines, develop Lung Cancer Screening Registry

Process improvement

FUTURE DIRECTIONS